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Thursday, December 17, 2009

Obamacare Kills

An enlightening op-ed was written for today's Wall Street Journal by Senator Tom Coburn (R-Okla). Coburn, who is also a practicing physician, warns that rationing provisions in the Senate health care bill, if passed, will lead to premature deaths.He cites the specific offending sections of the bill.

For instance, the Reid bill (in sections 3403 and 2021) explicitly empowers Medicare to deny treatment based on cost. An Independent Medicare Advisory Board created by the bill—composed of permanent, unelected and, therefore, unaccountable members—will greatly expand the rationing practices that already occur in the program. Medicare, for example, has limited cancer patients' access to Epogen, a costly but vital drug that stimulates red blood cell production. It has limited the use of virtual, and safer, colonoscopies due to cost concerns. And Medicare refuses medical claims at twice the rate of the largest private insurers.

Section 6301 of the Reid bill creates new comparative effectiveness research (CER) programs. CER panels have been used as rationing commissions in other countries such as the U.K., where 15,000 cancer patients die prematurely every year according to the National Cancer Intelligence Network. CER panels here could effectively dictate coverage options and ration care for plans that participate in the state insurance exchanges created by the bill.

Additionally, the Reid bill depends on the recommendations of the U.S. Preventive Services Task Force in no fewer than 14 places. This task force was responsible for advising women under 50 to not undergo annual mammograms. The administration claims the task force recommendations do not carry the force of law, but the Reid bill itself contradicts them in section 2713. The bill explicitly states, on page 17, that health insurance plans "shall provide coverage for" services approved by the task force. This chilling provision represents the government stepping between doctors and patients. When the government asserts the power to provide care, it also asserts the power to deny care.

Coburn also sees problems with the accounting assumptions made by the bill's crafters.

Other unintended consequences of the Reid bill could wreak havoc on patients' lives. What happens, for instance, when savvy consumers commanded to buy insurance realize the penalty is the de facto premium? It won't take long for younger, healthier Americans to realize it's cheaper to pay a $750 tax for coverage instead of, say, $5,000 in annual premiums when coverage can't be denied if you get sick.And Coburn uses his personal experience to illustrate in real-life terms the failings of the Senate's health care legislation.

But the most fundamental flaw of the Reid bill is best captured by the story of one my patients I'll call Sheila. When Sheila came to me at the age of 33 with a lump in her breast, traditional tests like a mammogram under the standard of care indicated she had a cyst and nothing more. Because I knew her medical history, I wasn't convinced. I aspirated the cyst and discovered she had a highly malignant form of breast cancer. Sheila fought a heroic battle against breast cancer and enjoyed 12 good years with her family before succumbing to the disease.

If I had been practicing under the Reid bill, the government would have likely told me I couldn't have done the test that discovered Sheila's cancer because it wasn't approved under CER. Under the Reid bill, Sheila may have lived another year instead of 12, and her daughters would have missed a decade with their mom.

Supporters of the bill would probably say that since Sheila died prematurely anyway it wasn't worth spending taxpayer money on the test.

Health care "reform" now making its way through Congress will provide - Government mandated insurance coverage with stringent requirements on what is covered. Rationing by third party bureaucrats whose first priority is cost control. A significant increase in the demand for health care without a corresponding increase in the supply of providers. Less choice and worse care with a substantial increase in overall cost to be paid for by patients, taxpayers and employers. The stifling of medical innovation, trillions of dollars added to the budget and slower economic growth with disincentives for employers to hire workers. Such a deal.